Assessment of lower urinary tract symptoms and health-related quality of life in patients undergoing ureteral rest prior to ureteral reconstruction.

Abstract

Background: Ureteral rest refers to the removal of hardware across a ureteral stricture, allowing for stricture maturation and stabilization, before ureteral reconstruction.

Objectives: We aimed to assess the potential impact of ureteral rest on lower urinary tract symptoms (LUTS) and health-related quality of life (HRQOL) in patients undergoing ureteral rest.

Design: Prospective, longitudinal, self-controlled study.

Methods: We included patients undergoing ureteral reconstruction between April 2022 and April 2025. We defined ureteral rest as replacing an indwelling double-J stent (DJS) with a percutaneous nephrostomy tube (PCN) prior to ureteral reconstruction. Primary outcomes were patient-reported LUTS (via International Prostate Symptom Score) and HRQOL (via Patient-Reported Outcomes Measurement Information System 29 v2.0). The secondary outcome was the incidence of urinary tract infections (UTIs). Questionnaires were completed prior to initiating ureteral rest (with a DJS) and after at least 3 weeks of ureteral rest (with a PCN). Continuous and categorical variables were compared using paired t-tests and chi-squared tests, respectively.

Results: Thirty-five patients met our study's inclusion criteria. With regard to LUTS, patients undergoing ureteral rest were found to have reduced urinary frequency (p = 0.001), straining (p = 0.03), and urgency (p = 0.0002). With regard to HRQOL, patients undergoing ureteral rest were found to have improved sleep disturbance (p = 0.04). There was no difference in UTI rates before and after ureteral rest (p = 0.48).

Conclusion: Patients undergoing ureteral rest prior to ureteral reconstruction may experience improvements in LUTS without compromising HRQOL outcomes or increasing the risk of UTIs.